摘要
为探索简便易行、适用于临床鉴别多囊卵巢综合征(PCOS)过多雄激素来源的方法,对11例雄激素增高的PCOS患者进行雄烯二酮(A2)与皮质醇(F)的同步释放试验、地塞米松抑制试验及舒经酚刺激试验,随后进行舒经酚诱导排卵治疗,对舒经酚耐药者辅以地塞米松治疗。结果:(1)4例A2与F的同步变化不明显,地塞米松对A2的抑制也不明显,舒经酚刺激后A2及雌二醇(E2)升高明显,舒经酚诱导排卵7个周期中5个周期排卵,提示过多雄激素主要来源于卵巢。(2)7例A2与F的同步变化明显,地塞米松对A2明显抑制,舒经酚刺激后A2及E2升高不明显,舒经酚诱导排卵13个周期中仅2个周期排卵。辅以地塞米松治疗后,2例排卵并获妊娠,表明过多雄激素除卵巢外,兼有肾上腺来源。提示综合舒经酚刺激试验与地塞米松抑制试验,以A2及E2为指标,可用于鉴别PCOS患者过多雄激素的不同来源,同步释放试验对鉴别也有一定意义,雄激素基础水平的测定对鉴别意义不大。
Objectives: To explore simple and practical methods to differentiate the source of hyperandrogenism in polycystic ovary syndrome (PCOS) patients.Design: Eleven hyperandrogenic PCOS patients and 14 normal controls were included in this study. The basic levels of testosterone, total and free, androstenedione (A2), DHEAS, LH, FSH, cortisol(F), and estradiol (E2) were measured, and pelvic ultrasonography was performed in all cases. Corcomitant releasing test of A2 and F, dexamethasone (DEX) suppression test and clomiphene stimulating test were performed and followed with 1~3 courses of clomiphene citrate (CC) 100 mg/d×5. Low dose DEX 0.5mg/d were added to CC failure cases.Results: In 4 of 11 cases, serum A2 level was less concomitant with F, suppression by DEX was not significant, but A2 and E2 increased significantly during with clomiphene stimulating test. Ovulation was induced successfully with a rate of 71.4%. In the remaining 7 cases, the concomitant test showed changes in A2 and F, serum A2 level was suppressed after DEX and no significant increase of A2 and E2 after clomiphene stimulation, the ovulation rate was only 15.4%. Addition of DEX increased ovulation in 2 and became pregnant.Conclusion: The levels of A2 and E2 in both the DEX suppression test and clomiphene stimulating test may be used in differentiating the source of hyperandrogens in PCOS patients, the former indicating ovarian and the latter companied with adrenal origin. The concomitant releasing test might be of some help, but the measurement of basic levels of androgens showed no significance in differentiation.
出处
《生殖医学杂志》
CAS
1998年第1期18-21,共4页
Journal of Reproductive Medicine